January News: Cows & Tractors

January 24, 2016

Happy New Year from the Congo!  Time seems to be flying by and January is already coming to a close.  Thank you for the many Christmas cards and greetings we received.  It is nice to hear from friends and family being away from home. We miss and love you!

The BIG news of the month is that we finally proud owners of a cow named “Imani” (Swahili for faith).

Warren has been talking about getting a cow so that we can have our own fresh milk.  She is quite pregnant and should calve sometime in February! At first glance she is intimidating with her large horns, especially when she walks towards you at full gait, but she is very friendly cow.  We have an ideal situation in that the backyard at the guesthouse next door has a large bamboo, fenced in yard for her to walk around.  She has plenty of grazing space in the surrounding fields during the day.  It should be fun to see a calf grow up as we learn how to care for it.  The other news is that we have a big, old tractor to prepare the fields and haul dirt.  Emmanuel loves to go for tractor rides with his dad.  It is nice to have a little bit of land to grow a few crops and room for hobbies like woodworking.

 A good nursing friend of ours, Karen Daniels, is here for the remainder of the month to help with organization of the operating theater and equipment, as well as patient care.  It has been a joy having her with us.  We would love to have an operating nurse like her full-time.  Systems are really critical to the working of a hospital and we really lack the personnel to help with the supply chain and improving the work environment. 

Our son Emmanuel is growing by leaps and bounds.  He is making more and more efforts to communicate, saying “What is this?”  When something is over he says, “Bye.”  All vehicles are “cars” and all animals are “Cocoas” (the name of his dog).  He loves to dance to any and all music,   He loves to share his toys and has learned where his friends Luke and Mariam live.  We have had some major struggles with sleep the last two months and are finally coming out on the other side.  Emmanuel has not wanted to go to sleep on his own, crying for hours, and waking in the middle of the night.  At times he seems that he wills not to sleep.  I think we finally made some progress this last week and we are on a workable schedule again.  We are relieved.  Learning to go to sleep on one’s own (among other developmental skills) is so important to everyone’s well-being.

In hospital news, CME Nyankunde just received a digital x-ray machine donation from Samaritan’s Purse.  We are so grateful and are busily learning how to take digital images.  In pediatrics news, this past year we successfully treated >30 children for tuberculosis.  I am still trying to wrap my head around the high incidence of disease, especially in the malnourished population.  It may be time for a more in depth public health screening/intervention.  I know we are only picking up the cases that come to the hospital.

Warren is busy as usual with many trauma cases and dealing with referrals for surgical complications.  This last week he operated on a 7year-old child with kidney stones causing kidney dysfunction and repeated infections.  It was a big operation and we are really hoping that he will recover complete kidney function.  Warren always seems to have new challenges hobble through the door.

Have you ever had the experience that you keep running into someone who is on your mind?  This past week we witnessed the passing of a life of a beautiful 2year old girl with a necrotizing pneumonia with accompanying bronchial injury, following surgical repair.  She was desperately ill, malnourished, and in the end she died despite our best efforts.  I keep running into this little girl’s mother- first in the village, then again yesterday I bought fish from her at the market.  I was beginning to wonder if I was imagining this woman, but it was indeed her.  Each time in my limited Swahili, I greet her and communicate my concern with a hug.  I really like this mother and really made a bond with her in caring for her daughter.  I know that the Lord wanted me to run into her multiple times this week.  Maybe the Lord knew that I needed this reminder to pray as I ought.  Let us remember to hold one another up in prayer in strength, in weakness, in joy, and in sorrow. 

Pray for the work of the hospital, that we would declare Christ boldly in words in action.

Pray for our son and continued good nighttime sleep.  Pray for good teamwork in our marriage.

Pray for the many needs of the hospital for materials and leadership.

Pray for the security of this country and health of many displaced populations.

Blessings in the Lord,

Lindsey

Merry Christmas from the Congo

December 27, 2015

Merry Christmas from the Congo!  It was Christmas morning and nothing was stirring, not even Emmanuel.  Celebrating the season is simply different overseas.  I have begun to realize all the cultural elements surrounding Christmas and the holidays in America….from holiday pajamas to ugly Christmas sweater parties, caroling to silly songs like “Grandma got runover by a reindeer,” expensive presents and fancy parties, baking cookies and peanut brittle, making snowmen and going ice-skating…the anticipation of Advent.  I miss some of these things, especially the changing of the seasons and the smell of fresh evergreen.

Congo Christmas is full of gatherings of friends and family, lots of food (foo-foo, rice, fried plantains, salad, goat or fish), maybe a new shirt, church services with lots of loud choirs, and of course benevolence for the poor.  The carols are different, there is no predominance of the colors red and green, and people have no idea what peanut brittle is.

I made a simple breakfast of grits and bacon (a rarity here), passionfruit juice, and our very own coffee blend.  I decorated the table with fresh poinsettia which grow taller than the average person, from our yard.  We listened to some traditional Christmas carols.  After breakfast I’m off to check the chicken house for eggs.  I will make some dessert when the chickens lay eggs…no pressure chickens but get going! Then we gave Emmanuel his presents including a life-size elephant he has affectionately named “Boppie” and a play tent with a connecting tunnel.  Before church we read the   Christmas account from the book of Luke.  This year I marveled at how the response of everyone is praise and thanksgiving to God for this baby.  This is true of the angels, the shepherds, Simeon, Anna, and the kings.  They didn’t meet this news with doubt and ridicule…it was as if God had already prepared their hearts to accept and rejoice in what they were to witness.  In the afternoon we joined the Larochelle family for a meal with some of their Congolese friends.  They bought a goat to help support a family’s needs in the community and we shared the proceeds together.  A good time was had by all! 

Our Christmas tree is about 4 feet off the ground, away from Emmanuel’s curious hands and our puppy.  I look forward to seeing the wonder in his eyes as he begins to understand some of these traditions…he is still too young.  It is fun to create our own traditions, a blending of both cultures.  Emmanuel must think that all the songs we sing this time of year are about him!   My guess is that he won’t really be exposed to Santa Claus out here.

Coffee

We are reaping the benefits of Warren’s first long-awaited coffee harvest.  We have learned that harvesting coffee is a lot of work, but quite interesting!  Actually every step in coffee growing, harvesting, preparation of the beans, and roasting is a lot of work!  I now have a great appreciation for the time that goes in to one bag of coffee from Starbucks.  I think we won’t need to buy coffee anymore, although we will accept gifts of Starbucks coffee from visitors.

Safari

We just returned from a trip to the Kenyan coast for some fun in the sun before Christmas.  It was   How much fun it was to see Emmanuel encounter the ocean tide for the first time!  He ran towards the water and then turned around when he realized the water was chasing him.  Curiosity is a strong force when you are 16months old, so he soon found himself feeling pulled (literally!) back towards We spent a lot of the day swimming in the pool.  Emmanuel is quite the socialite, making friends wherever he goes.  He gets a lot of attention with his beautiful curly blond hair, infectious smile, and cute way of saying “hi.”  Emmanuel enjoyed dancing in the evenings with some of the staff…it is really fun to see how he has no fear of crowds.  One evening he was in the circle with the lead dancer while people danced all around him. 

On stage, no fear

 

The trip was good timing as the hospital census was not very high. The steamy heat, warm Indian Ocean, and sand were relaxing.

Traveling with a small child is a challenge.  Our son is VERY active and has a strong will without much discernment.  We are learning that children are quite flexible, but really thrive on routine.  He seems to be very happy in his home, eating in his highchair, sleeping in his own bed, chasing chickens, and playing with his dog Cocoa. 

Back to the Hospital

We are back to work in the hospital after the Christmas holidays.  It’s funny but there are always people getting sick and crashing their   motorcycles.  We will always have work this side of heaven.

It is our prayer that you will hear and experience this “good news of great joy that will be for all people.”  May our hearts be filled with joy for this baby that came to redeem and renew the broken world.

Blessings and love,

Lindsey for the Coopers

A few days with our friends the Samuel family in Uganda
(he is sitting on an elephant outside Nakumatt)

Well worn shoes

December 11, 2015

Another month has flown by and Advent is upon us!  I am getting used to a tropical Christmas where palm trees are more frequent than the conifer variety.  Have you ever consider how many kilowatts your Christmas tree consumes?  Here we are very conscious of electricity….plugging in a Christmas tree on a cloudy day means inadequate photons in compared to photons out.

We are leaving for a short beach vacation in Mombasa prior to Christmas.  I have been wanting to sink my toes in a warm sandy beach, play with Emmanuel in a pool, and enjoy good food.  It seems like a great time to get away when the hospital census is not so high.  I think scuba diving an probably even snorkeling are out with a very active 1-year old, but we will have a blast eating mangoes and coconuts and running like crazy after crabs.

Memorable Patients & The Value of Counseling

I have had several very memorable patients recently.  I have grown in friendship with several of the mothers of my patients.  A little girl that I met almost 3years ago who is now 4 is recovering wonderfully from her tuberculosis…such a victory.  It is a joy to see a child come full circle and to  

feel joy with the family.

 I discharged a young girl named Here admitted over a month ago with severe malnutrition and a   Following surgery and starting on treatment for tuberculosis she has improved very dramatically.  She returned to a Medecin Sans Frontieres hospital for follow-up care.  She told me she wanted to be a teacher someday and about how happy she was to feel well again.   We have had a lot of wonderful cures lately.  

tuberculoma causing a bowel obstruction.

I have been doing a fair amount of HIV counseling lately with the director of the health center.  I am learning how to communicate directly, yet compassionately while presenting HIV as a chronic disease like so many others.  HIV is yet another disease that one lives with and that is not cured this side of heaven.  It is a very emotional experience to have to share this news with each parent and then see them go through various stages of disbelief, anger, grief, acceptance.  Pediatric HIV counseling is more complicated than simply informing one person that they are “affected,” rather it involves disclosure and counsel of three people.  I have seen marital conflict, avoidant behaviors, and a number of other unhealthy responses.  The first step in counseling is to promote understanding and acceptance.  The second step is to advise each parent/other children to get tested.  The third step is to manage the disease with retroviral drugs and treat infections.  It is my prayer that with time one family will come to terms with their child’s disease and seek help themselves.  For yet another family, I pray that their marriage will remain strong and supportive.  

A Typical Day for Lindsey

At night I collapse in bed and look back on the events of the day.  Aside from my hospital work I spend a lot of time with Emmanuel and in food acquisition and preparation.

I started the day with rounds and consultations from 8/8:30-1pm.  Returning home at 1pm, I fed Emmanuel and eat lunch.  Emmanuel and I played for a couple of hours until he was sufficiently tired and ready for a nap.  Often he takes an afternoon bath outside.  While Emmanuel was sleeping, I cooked one of my favorite meals:  beef peanut stew with coconut rice with fried okra.  Then various tasks in the guesthouse, organizing the storage of flour and rice in large drums, weeding the herb garden, putting away laundry, and a little bit of correspondence.  When Warren got home Emmanuel learned how to pick up baby chicks without harming them!  Then we went for a walk, bought some   Finally home for dinner, clean-up, rocking Emmanuel to sleep, and it’s already 9pm!  Our little boy has been having some difficulty with nighttime waking and getting back to sleep, so we anticipate a 2am wake-up.

Emmanuel and his friend Favredi

vegetables, and visited a family with a pet duiker to see its’ amputated leg.

As I write this from the comfort of my well-lit, cozy room I realize that local Congolese women have a much more difficult life.  They wake up at sunrise to transport water from local water sources, work in the fields, harvest wood for cooking, travel on foot to local markets, cook meals, take care of their children and husbands…perhaps hold a job, but likely not.  Much of the day revolves around providing for the needs of their families, food and otherwise.  The same is true for me, but I have the luxury of running water, a stove to cook on, and help around the house with laundry and housekeeping tasks.

I love being a mother.  Emmanuel is learning so many things everyday.  We joke that he probably runs a 5K everyday.  His shoes are falling apart!  Why walk when you can run or climb?  He climbs everything and anything he can find!  Emmanuel goes through about 3 sets of clothes a day and I go through at least 2 sets from playing with him!  His little “hi” and “bye” are charming, as is his little wave.  Instead of “up” he says “uppy, like “puppy.”  He knows a few words in French, Swahili, and of course English.  I love that his nanny speaks with him in Swahili. 

A Difficult Lesson

Have you ever missed the opportunity to tell someone an important message?  There was a young woman who died last night after many complications following surgery to repair her bowel and damaged uterus.  One of the nurses and I had planned to spend some time sharing the Gospel with her yesterday, but all the medical cases took precedence so we planned to do it this morning.  Then she died before we came back.  Ohh, such a difficult reminder that THIS is so important and worth leaving other medical tasks aside.  We are all mortal and will die someday.  It is my prayer that someone was able to speak with her and that she accepted the Lord into her life.  May the Lord show us how to incorporate the Gospel and words of hope into our daily work.  

It is true what the angel Gabriel said, “ I bring you good news that will cause great joy for all the people” (Luke 2:10). 

May you be filled with joy this Christmas season as you await Him coming,

Lindsey

The kid gang of Thanksgiving

 Thanksgiving Samaritan's Purse style in Bunia

Artificial nose

How does one go about creating a new nose for someone who is lacking one?  This young man was attacked by a hyena while he was sleeping. The hyena bit off his nose and chewed on his face. The horror of such an event really cannot be imagined. He survived, but spent the next five years healing the wounds. The MSF team found him and asked me if I would be willing to try something. Normally I get exited about a challenge but I found myself dreading this case. There is a lot to lose. It is possible that the flap will die and then you have burned bridges and mutilated the patient even further. I would have preferred to send the boy to see a real Plastic Surgeon. Unfortunately there aren't any around here, and there were no funds to send him elsewhere. In these cases, you just bite the bullet and do the best you can. 

When in doubt, read. After investigating the options, I decided to go with the "Converse scalping flap". I actually saw one of these on the Mercy Ship, some years ago. It looks nice and neat on paper.  The reality is really quite different. 

Nasal reconstruction was one of the pioneering procedures in plastic surgery. This is partly due to the fact that amputation of the nose was a common punishment in India and other countries. This case was going to be tough because the whole nose was missing. I had to recreate both layers, the inside and outside. As the septum was gone, I would have to make do with a single common nasal chamber. 

This was the first step; to fashion a forehead flap which could be turned down and constitute the inside of the nose. 

The nose itself was created from a forehead flap.  This involves basically scalping the patient so the flap  will have sufficient blood supply. This leaves a big defect behind.  The area of the nasal flap is covered with a full thickness skin graft from the groin. 

The completed first phase is not pretty, by any means, but there is at least tissue over the hole. You're supposed to wait three weeks before cutting the bridge. You need blood supply to grow in from the wound edges. This kid had a some breakdown of the wound edges and an infection, so I waited an extra week. 

This is after the second phase of the operation. The bridge of the flap has been divided, the scalp has been put back in a place and another skin graft from the groin has been used to over the defect that remains.  Again, it's not pretty, but the gaping hole has been covered by something that vaguely resembles a nose.  It lacks any real support and it will need some work in the future. 

Throughout the whole ordeal this child has remained remarkably stoic. No emotion at all!  Is he happy about the procedure?  I have absolutely no idea!

The nose is a beautiful thing. You don't realize this until you see a person who lacks one. The expression "cutting off one's nose to spite one's face" is an illustration. This expression originated from an event which took place in 867 AD. Vikings attacked a convent in Scotland. The Mother Superior chose to disfigure herself by cutting off her nose and upper lip in order to preserve her chastity from the marauders. She urged other nuns to do the same. The attackers were so disgusted that they burned the building to the ground, with the nuns inside. Not sure if this strategy would be considered a success or a failure. 

These cases are hard on me. I work so hard, and in the end, the final result is something like, "well, he doesn't look quite as horrible as before!"  My prayer is that he will return home, glorying God for what has been done. We have shown him compassion and have done our very best for him. 

Things are going well here. I've been ill for the past two weeks or so. This has made me irritable and hard to get along with. I feel like I'm pulling through and hope to soon be back to my good-natured self. 

My apologies for a fairly technical post. It may not be everyone's cup of tea, but this is what I do. 

Warren